Chiropractic patients in the Netherlands: A descriptive study

Abstract

Background: Despite the worldwide popularity of chiropractic, there is still relatively little known about the patients who visit chiropractors in the Netherlands and other European countries. Objective: To describe in-depth the patient population of new patients to chiropractors in the Netherlands. Design: Study population consisted of 10 consecutive new patients per participating chiropractor. A retrospective-type questionnaire was used. Setting: Private practice. Outcome Measures: Mode of referral, area, and nature of the complaints; related to the chief complaint: previous treatments, examinations, type of referral, days lost at work, level of pain, and treatment expectations. Results: Of the 130 chiropractors registered with the Netherlands Chiropractors'Association, 94 chiropractors(78%) participated. Eight hundred thirty-three patients (89%) returned questionnaires. By far, the greatest reason that patients visit chiropractors in the Netherlands is for neuromusculoskeletal (NMS) complaints. At the time of examination, 86% of the patients had spinal-related complaints, of which 12% involved multiple areas of the spine. Non-NMS complaints are minimal (<2%). Seventy-seven percent of patients with NMS complaints have chronic complaints (>12 weeks). Three-quarters of these patients have undergone previous conservative therapy for their complaint, which includes physical and manual therapy, postural correction, and exercise therapy. Despite the chronic nature of their complaints, patients have high expectations that their treatment will be effective. Conclusions: Most patients who see chiropractors in the Netherlands have chronic NMS-related complaints. Chiropractors are not a part of the normal referral system in this country, with the result that the patients have rather long histories, including previous evaluations by medical specialists and other previous forms of (conservative) care. (J Manipulative Physiol Ther 2000;23:557-63)

Introduction

Despite the growing popularity and acceptance of manual therapies in the treatment of neuromusculoskeletal (NMS) conditions, there is still relatively little known about chiropractic in various countries where it is practiced. Although chiropractic is widely used in English-speaking countries, little is known about chiropractic in the non-English countries of Europe.

Purely descriptive studies have been performed in the past in the United States,1, 2, 3, 4, 5, 6, 7 Canada,8, 9, 10 and Australia,11, 12 looking, for example, at the number of patients who visit a chiropractor, their complaints, their expectations of care, their sources of referral, and satisfaction with care. Some studies have even included treatment outcomes.13, 14 Recent descriptive studies of chiropractic care in the United States, Canada, and Australia have focused more on pain profiles, comparing the complaints of patients at different chiropractic teaching clinics and of private clinicians15, 16, 17, 18; other studies have looked at the psychologic profiles of patients.19, 20 By comparison, relawtively few studies have been performed in Western Europe.21, 22, 23, 24 A recent survey of 14 European countries focused on the chiropractor yet provided comparatively little information about the patients.²⁵

Despite the fact that chiropractic has existed 30 years in the Netherlands, it is still often regarded as an obscure form of therapy. This is reflected in various aspects. First, the costs of chiropractic care are not included in the standard health care package; therefore, patients have to purchase supplemental coverage. Second, many general practitioners are reluctant to refer their patients to chiropractors, instead referring them to manual therapists.²⁶ Third, there is no formal legal recognition of the chiropractic educational training nor protection of the title. Finally, health care is regulated and controlled by a medical gatekeeper (ie, general practitioner) in this country; thus, many patients who visit the chiropractor do so only after having had the standard forms of conservative care. Consequently, it is believed that many patients who visit chiropractors have chronic complaints and therefore a less favorable prognosis for recovery.²⁷ This is supported by recent publications that examined chiropractic use by patients in Europe in general and Sweden in particular, where it was found that those patients who sought out chiropractors tended to have chronic complaints.25, 28

Yet despite this, the position of chiropractic in the Netherlands is improving. In this decade, the number of practicing chiropractors in Holland has more than doubled.²⁹ And, despite the prejudice against chiropractic that is eminent in a medically based community, many chiropractors report to have a waiting-list practice. Moreover, there is wide acceptance of spinal manipulation in the Netherlands, even though most referrals for manipulation are performed by non-chiropractors.

It was, in essence, the results from a positive patient satisfaction survey published in 1989 in the Netherlands³⁰ that later prompted a government-funded study by Assendelft et al³¹ on chiropractic in the Netherlands. Essentially, this article serves as the companion piece to that reference²⁹ in which only the chiropractic practitioners were surveyed. The addition of a patient profile, such as was attempted by this project, gives a better perspective of chiropractic in this country. Therefore, this study was undertaken to describe in detail the patient population of chiropractors, gathering information on such topics as clinical complaints, modes of referral, previous examinations and treatments, degree of pain, expectations with treatment, and lost days of work.